Back Pain and Chiropractic

The U.S. Department of Health and Human Services’ Agency for Health Care Policy and Research (AHCPR) assembled a panel of experts (21 M.D.s and 2 chiropractors) to review the research on back care. The panel’s report, “Guidelines for Acute Lower Back Pain,” included a ringing endorsement of chiropractic.

Here’s why:

At the Medical College of St. Bartholemew’s Hospital in London, British researchers randomly assigned 741 people with back pain to either chiropractic or mainstream medical treatment. The participants all completed questionnaires about their back pain after six weeks, six months, one, two, and three years. At every interval, those receiving chiropractic care reported greater improvement. After three years, the chiropractic group had 29 percent less pain, and significantly less difficulty sitting, sleeping, lifting heavy objects.

At the University of Limburg in Maastricht, the Netherlands, researchers gave 256 people with back and neck pain one of four treatments: physical therapy (heat, electrotherapy, exercises), standard medical care (bed rest, pain-relieving drugs, exercises), chiropractic, or placebo (sham physical therapy). After one year, those receiving chiropractic reported the most improvement, followed by physical therapy, standard medical care, and placebo.

Paul Shekelle, M.D., M.P.H., a staff researcher with the RAND Corporation in Santa Monica, California, analyzed 25 well-designed studies that compared rest with chiropractic for back and sciatic nerve pain. For back pain, those receiving chiropractic were 17 percent more likely to report recovery within three weeks. For sciatic pain, recovery within three weeks was 10 percent more likely with chiropractic.

Researchers at Mills College, in Oakland, California, analyzed 23 studies comparing chiropractic treatment of back pain with many other therapies: rest, drugs, exercises, physical therapy, acupuncture, etc. Chiropractic “proved to be consistently more effective than any of the array of comparison treatments.”

California researchers surveyed a large group of back-pain sufferers, some of whom were treated by family M.D.s, while others consulted chiropractors. In the family doctor group, 22 percent said they were “very satisfied” with the results. Among those receiving chiropractic, however, 66 percent reported being “very satisfied.”

Finally, researchers at the Los Angeles College of Chiropractic in Whittier, California, analyzed the cost of 3,062 workers compensation claims for back pain in Utah for 1986. Compared with standard medical care, chiropractic care cost substantially less.

Back in the days before mainstream medicine dropped its objections to chiropractic, some doctors called it dangerous. It isn’t according to back care specialist Richard Deyo, M.D., a professor of medicine at the Univeristy of Washington School of Medicine in Seattle, and a member of the AHCPR panel that reviewed chiropractic. For the 80-year period from 1900 to 1980, medical journals reported 135 complications from chiropractic manipulation. Considering the millions of people treated by chiropractors during that time—an estimated 20 million annually in recent years —Dr. Deyo called the risk of complications “extremely rare.”